BVA9504719
DOCKET NO. 93-10 364 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in San Francisco,
California
THE ISSUE
Entitlement to service connection for coronary artery disease, to
include hypertension.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
G. Wm. Thompson, Counsel
INTRODUCTION
The veteran had active service from September 1955 to April 1959.
This appeal arises from an August 1992 Department of Veterans
Affairs (VA) San Francisco, California, Regional Office (RO)
rating decision that denied service connection for coronary
artery disease. In deciding the claim the RO clearly considered
and addressed the evidence on file of the veteran's blood
pressure during and after service. Accordingly, the issue is
properly framed as shown on the preceding page.
It appears that the veteran may also be claiming service
connection for his cardiovascular disease as secondary to
service-connected residuals of a head injury, although to date
there is no medical evidence of the claimed relationship. That
matter has not been specifically adjudicated by the RO and is
referred for consideration.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends, in essence, that the RO erred in not
finding that the evidence of record supports his claim for a
hypertensive heart condition. He points out that service medical
records show elevated blood pressure readings, even before a
serious accident. He asserts that he had undiagnosed
hypertension during service, and that the condition was finally
recognized after service.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that the claim of entitlement to service connection for
coronary artery disease, including hypertension, is not well
grounded.
FINDINGS OF FACT
1. Evidence sufficient for an equitable disposition of this
appeal has been obtained by the RO.
2. The veteran had elevated and normal blood pressure in
service, without a diagnosis of hypertension or evidence of
coronary artery disease.
3. There is no medical evidence or opinion linking current
hypertension and coronary artery disease with the veteran's blood
pressure in service about 20 years earlier or any other incidents
of his remote service.
CONCLUSION OF LAW
The claim of entitlement to service connection for coronary
artery disease, to include hypertension, is not well grounded.
38 U.S.C.A. § 5107(a) (West 1991).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Pursuant to 38 U.S.C.A. § 5107(a), a person who submits a claim
for benefits under a law administered by the Secretary shall have
the burden of submitting evidence sufficient to justify a belief
by a fair and impartial individual that the claim is well
grounded. The United States Court of Veterans Appeals (Court)
has held that a well-grounded claim is a "plausible" claim, one
which is meritorious on its own or capable of substantiation.
Such a claim need not be conclusive but only possible to satisfy
the initial burden of § [5107(a)]." Murphy v. Derwinski, 1
Vet.App. 78,81 (1990). The Court has also held that although a
claim need not be conclusive, the statute provides that it must
be accompanied by evidence that justifies a "belief by a fair and
impartial individual" that the claim is plausible. Tirpak v.
Derwinski,
2 Vet.App. 609, 610 (1992). The Court has also held that "where
the determinative issue involves medical causation or a medical
diagnosis, competent medical evidence to the effect that the
claim is 'plausible' or 'possible' is required."
Grottveit v. Brown, 5 Vet.App 91, 93 (1993) (citing Murphy, at
81).
The basic law and regulations pertinent to the veteran's claim
for service connection provide that service connection can be
established if a particular disease or injury, resulting in
disability, is incurred coincident with service; or it if
arteriosclerotic cardiovascular disease, including hypertension,
is manifested to a compensable degree within one year after
service. Presumptive periods are not intended to limit service
connection to diseases so diagnosed when the evidence warrants
direct service connection. For a showing of chronic disease in
service there is a required combination of manifestations
sufficient to identify the disease entity, and sufficient
observation to establish chronicity at the time, as distinguished
from merely isolated findings or a diagnosis of "Chronic." Where
the disease identity is established, there is no requirement of
evidentiary showing of continuity. Continuity of symptomatology
is required only where the condition noted during service or the
presumptive period is not, in fact, shown to be chronic. Where
the fact of chronicity in service is not adequately supported, a
showing of continuity after discharge is required to support the
claim. 38 U.S.C.A. §§ 1112, 1113, 1131
(West 1991); C.F.R. §§ 3.303(a)(b)(d), 3.307, 3.309 (1994).
The Facts
The veteran, in a statement dated in March 1993, has referred to
medical literature that defines systolic blood pressure above
140 and diastolic blood pressure above 90 as hypertensive.
The service medical records show that the veteran's blood
pressure was 150/50 when he was examined for enlistment into
service in September 1955. In February 1956, when he was
hospitalized for tonsillitis, his blood pressure was 120/88. He
underwent a tonsillectomy. After the operation was completed
his blood pressure was 130/90. When he was hospitalized in March
1956 for a excision of a perianal growth, his blood pressure was
146/100. The records pertaining to the above periods of
hospitalization do not reflect references to hypertension or
cardiovascular disease.
The veteran suffered a severe head injury on April 4, 1956, and
multiple blood pressure readings were recorded from April 4th
through the 13th. It appears that the initial readings, taken at
intervals of one hour or less, were 180/50, 120/84, 122/90,
120/100, 126/95, 130/86, 136/86, 150/90 and 140/90. According to
a narrative summary, the veteran underwent emergency cranial
surgery and had a "stormy" post-operative course. He underwent
additional surgery on the third post-operative day and again in
June 1956. The medical records pertaining to his period of
hospitalization reflect numerous blood pressure readings which,
using the criteria mentioned by the veteran in support of his
claim, were normal on some occasions and elevated on many others.
The veteran was discharged from the hospital in August 1956. The
records of hospitalization do not contain any diagnoses of
hypertension or coronary artery disease.
When the veteran was hospitalized in March 1959 for coccygeal
surgery, there was no finding of high blood pressure reported.
When he was examined in April 1959, prior to discharge from
service, his blood pressure was 114/68. There was no history or
diagnosis of hypertension noted on the examination report.
Service connection has been granted for the residuals of the
veteran's head injury and for other disabilities.
When the veteran was examined by the VA in April 1960, his blood
pressure was 120/80. No abnormalities were found on clinical
examination of the cardiovascular system and the heart was
described as "normal in all respects." A chest X-ray was normal.
The diagnoses did not include hypertension or cardiovascular
disease.
The earliest subsequent evidence regarding the veteran's blood
pressure is a May 1981 VA outpatient treatment record that shows
pressure of 132/92 and refers to the medications Dyazide and
Propanolol. When the veteran was treated by the VA in June 1981
for a condition not at issue, his blood pressure was 158/100.
During hospitalization later that month for hemorrhoid surgery,
hypertensive vascular disease was diagnosed. In hearing
testimony in November 1992 the veteran indicated that he had
memory loss associated with his service-connected head injury,
and did not remember being given medication for hypertension in
1981.
VA outpatient records dated in the late 1980's indicate continued
treatment for hypertension. According to a record of March 1989,
hypertension had been found "a few years ago." In June 1992 the
veteran reported having recently undergone open heart surgery at
a hospital in Palo Alto, California. He did not identify the
facility or request that hospital records be obtained.
The veteran testified in November 1992 that he first learned of
his high blood pressure when donating blood and that he began
donating blood in about 1959 or 1960. He also testified that he
was told at blood banks that his blood was "on the border," but
that "[I]t wasn't high blood pressure." Transcript, 4. He did
not believe that any pertinent records were still available.
Transcript, 8.
Analysis
Under the standards cited by the veteran, he had elevated
systolic blood pressure on entering service and entirely normal
blood pressure at discharge. In the interim, he had both
elevated and normal readings. The elevated readings often, but
not always, were contemporaneous with illnesses, injuries and
surgery. Subsequent to the normal pressure noted on the service
discharge examination, the next blood pressure of record was a
120/80 (normal under the standards mentioned by the veteran)
reading on a VA examination in April 1960. The veteran's
cardiovascular system was found to be normal at that time. The
next pertinent evidence was about 20 years later, when a
diagnosis of hypertensive vascular disease was recorded.
There has been no competent evidence presented or identified
tending to show that chronic high blood pressure or coronary
artery disease was present during service or compensably
manifested within a year thereafter. Also, there is no medical
evidence that relates the veteran's current coronary artery
disease with hypertension to the elevated blood pressure readings
or any other incidents of service. The veteran's testimony
regarding the early post-service period was to the effect that he
was told at a blood bank that his blood pressure was borderline
but that it "wasn't high blood pressure." Even if a doctor,
rather than the veteran, presented this testimony, it would not
establish a well-grounded claim inasmuch as the statement
indicates that the veteran did not have actual high blood
pressure. According to the veteran and his representative at the
hearing, any records of his donating blood more than 30 years ago
likely would no longer be available. Transcript, 8.
There is no objective medical evidence that the blood pressure
readings in service represented hypertensive disease and there is
no evidence of coronary artery disease until decades after
service. Further, there is no medical evidence linking the
veteran's blood pressure in service to the hypertensive vascular
disease and the coronary artery disease shown in the early
1980's, at which time it was noted that hypertension had been
found only "a few years ago." The veteran himself is not shown
to possess the medical expertise to determine the etiology or
time of onset of his cardiovascular system disorders or their
relationship, if any, to service. Espiritu v. Derwinski, 2
Vet.App. 492 (1992). Accordingly, it is concluded that the claim
for service connection is not well grounded.
In a March 1993 statement, the veteran cited Satchel v.
Derwinski, 1 Vet.App. 258 (1991) in support of his claim for
service connection. The issue before the Court in Satchel was an
earlier effective date for payment of dependency and indemnity
compensation, a different issue from that now before the Board.
While the veteran has argued that in the Satchel case, service
connection had been granted based on 26 high blood pressure
readings during hospitalization in service and that his service
medical records reflect more than 26 elevated readings, the
entire facts of that case were not set forth in the Court
opinion. Moreover, regulations provide that although the Board
strives for consistency in issuing its decisions, previously
issued Board decisions will be considered binding only with
regard the specific case decided. Prior decisions in other
appeals may be considered in a case to the extent that they
reasonably relate to the case, but each case presented to the
Board will be decided on the basis of the individual facts of the
case in light of applicable procedure and substantive law. 38
U.S.C.A. § 7104(a) (West 1991); 38 C.F.R. § 20.1303 (1994).
Accordingly, the Court's decision in Satchel does not reasonably
relate to the veteran's claim, and prior Board decisions are
nonprecedential in nature. 38 C.F.R. § 20.1303.
ORDER
The claim of entitlement to service connection for coronary
artery disease, including hypertension, is dismissed.
JANE E. SHARP
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988. Veterans' Judicial
Review Act, Pub. L. No. 100-687, § 402 (1988). The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.